OP
OP
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Guess this can go here
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In December 2016, I was hospitalized with severe electrolyte abnormalities that were causing fatigue, muscle cramps and chest discomfort. I received care at my local hospital, which was nationally ranked both overall and in the treatment of endocrine conditions, and I recovered fully.
A month later, my heart sank as I received a letter from Aetna informing me that the hospitalization, amounting to nearly $30,000 in treatment, had been deemed not medically necessary. Coverage was denied.
The case had seemed crystal clear. My calcium level was below the critical value of 6.0. My magnesium and potassium levels were likewise below normal. I was experiencing chest discomfort and pain and was at risk of cardiac arrhythmia.
What’s more, I was struggling to keep oral medications down, making it even more difficult to recalibrate my electrolyte levels at home. My admission was a slam dunk, endorsed by both the emergency medicine and endocrine physicians.
But in the insurer’s eyes, the treatment was not necessary. I was livid.
I was a new political science professor, and busy juggling new courses. In between classes, I called Aetna to try to resolve the matter, but the long wait times were exasperating.
Instead, I tweeted my frustrations about the denial and tagged the company. I did not know if they would respond, but I wanted whoever monitored the account to be made aware. Perhaps equally importantly, I wanted to get this exasperation off my chest.
To my surprise, Aetna replied, inviting me to connect with them. When I did so, they provided a social media-specific email I could contact.
I explained my medical issue very plainly over email, saying that I had needed multiple days of intravenous calcium replenishment and fluids and cardiac monitoring before I could be safely discharged.
Soon, an Aetna staffer informed me by phone that they could not see why the claim was denied and that it may have been an error. The denial was reversed before I ever saw a hospital bill.
Social media outreach is not the conventional avenue through which to challenge health insurance-related delays and denials, but it can be effective.
published a 2014 piece on the value of complaining on Twitter about health insurance barriers, and a 2023 NBC investigation highlightedboth patients’ and physicians’ reliance on public shaming as a mechanism to overturn denials of prior authorization, or requirements of insurer pre-approval for certain types of healthcare.
Why had this worked for me? Because I could cite lab values and relevant risks, thanks to my academic training and a lifetime of navigating the US healthcare system as someone with chronic medical conditions?
Was it easier for them to pay the claim than to risk bad PR resulting from an angry enrollee’s persistence?
I probably had in the ballpark of 5,000 Twitter followers at the time – not enormous, but above average.
Either way, why did it have to come to this? My experience of going through the regular appeal process had been so exhausting…….
My $30,000 health insurance claim was denied. Then I tweeted about it
Public shaming works – but it’s also a sign of how broken the appeals process is in the US health insurance industry